Date: ____________________

Name: ___________________________________________________________

Delivery Address: _______________________________________________

     ____________________________________________________________
     
     ____________________________________________________________

Your email address and phone will be used only if we have a 
question and to notify you when it's time to renew your 
subscription.  We won't share your information with anyone else.

Email: __________________________________________________

Phone: ______________________________

I wish to give a gift to:

Name: ___________________________________________________________

Delivery Address: _______________________________________________

     ____________________________________________________________
     
     ____________________________________________________________

For my own subscription:...........$12 X ____ years = $ _________
               
For my gift subscription:..........$12 X ____ years = $ _________
To whom should the renewal notice for this gift be sent?
  
    _______________________________________________

                               Total Amount Enclosed: $ _________